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Imaging congenital anomalies of the ileum in adults:a pictorial review. Abdom Radiol (NY) 2023; 48:502-509. [PMID: 36401130 DOI: 10.1007/s00261-022-03739-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.
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Ravi Kumar D, Niranjan B, Kumar Kandi P. MECKELS DIVERTICULUM WITH MESENTERY AS A RARE CAUSE OF CLOSED LOOP OBSTRUCTION-A CASE REPORT. GLOBAL JOURNAL FOR RESEARCH ANALYSIS 2022:40-41. [DOI: 10.36106/gjra/7401212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Meckel's Diverticulum is most common congenital anomaly of gastrointestinal tract. It arises from Antimesenteric border of the small bowel [1]. In contradiction, a case encountered at our institution where a
32-y old female presented with complaints of pain abdomen since 3 days, vomiting's since 3 days, obstipation since 3 days and
distention since 1 day. On examination abdomen is distended, diffuse tenderness present all over the abdomen with no bowel
sounds and collapsed rectum with no fecal staining per rectally. Imaging studies on ultra-sonography shown dilated small
bowel loops with max diameter of 3.1cm showing to and fro peristalsis. On CT abdomen multiple dilated small bowel loops with
air uid levels with maximum diameter of 4.1cms with collapsed terminal ileum and large bowel. ?Closed Loop Obstruction.
Emergency exploratory laparotomy was planned and shown Meckel's diverticulum with mesentery present on anti-mesenteric
border with mesentery extending from mesenteric border to tip of Meckel's diverticulum with internal herniation of proximal
ileum between the Meckel's and its mesentery causing closed loop obstruction noted at 60cms from IC junction for which
herniated bowel loops was released with diverticulectomy followed by anastomoses of proximal and distal ileal loops.
Resected Meckel's sent for histopathological examination and cut section showed mucosa, sub-mucosa, muscularis propria
and serosa. Mucosa shows chronic nonspecic inammation, sections from the adjacent area's shows hyperplastic mucosa,
hypertrophied muscularis layers and serosa with congested blood vessels with feature's consistent with Meckel's diverticulum.
Patient was followed for 6 months, and the course was un-eventful.
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Affiliation(s)
- Dappu Ravi Kumar
- Assistant Professor In General Surgery, Osmania General Hospital, Hyderabad, Telangana State
| | - Batta Niranjan
- Post Graduate Resident In General Surgery, Osmania General Hospital, Hyderabad, Telangana State
| | - Pranesh Kumar Kandi
- Post Graduate Resident In General Surgery, Osmania General Hospital, Hyderabad, Telangana State
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Kelahan L, Menias CO, Chow L. A review of internal hernias related to congenital peritoneal fossae and apertures. Abdom Radiol (NY) 2021; 46:1825-1836. [PMID: 33128101 DOI: 10.1007/s00261-020-02829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023]
Abstract
Congenital-type internal hernias have the potential to cause small bowel obstruction well into adulthood. Congenital-type internal hernias include left paraduodenal, right paraduodenal, foramen of Winslow, pericecal, sigmoid mesocolon, transomental, small bowel mesentery, and broad ligament hernias. This review summarizes CT imaging features and complications of congenital internal hernias using a systematic approach based on abdominopelvic quadrants and key anatomic features. CT imaging will continue to be commonly used to evaluate abdominal pain. Anatomical landmarks and characteristic CT findings can help identify congenital internal hernias as a potential cause of abdominal pain.
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Affiliation(s)
- Linda Kelahan
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 800, Chicago, IL, 60611, USA.
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Lawrence Chow
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
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Zhang Y, Guo Y, Sun Y, Xu Y. An internal hernia caused by Meckel's diverticulum: a case report. BMC Gastroenterol 2020; 20:69. [PMID: 32164577 PMCID: PMC7069052 DOI: 10.1186/s12876-020-01211-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meckel's diverticulum is a remnant of the omphalomesenteric duct. It can lead to intestinal perforation, obstruction and gastrointestinal bleeding. While the internal hernia caused by Meckel's diverticulum is rarely reported. CASE PRESENTATION We report a case of a 45-year old female patient who presented with intestinal obstruction and on laparotomy was found to have Meckel's diverticulum with internal hernia causing intestinal gangrene. Segmental bowel resection was performed and the patient had uneventful recovery. CONCLUSIONS In patients with acute intestinal obstruction without previous abdominal surgery, Meckel's diverticulum and its complications should be suspected.
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Affiliation(s)
- Yang Zhang
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yuchen Guo
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yuanlin Sun
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yuechao Xu
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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West C, Erskine K, Hamdan K. Transthoracic Littre's hernia presenting with faecopneumothorax following perforation of the Meckel's diverticulum: a late complication of oesophagectomy. BMJ Case Rep 2017; 2017:bcr-2017-220902. [PMID: 29054892 DOI: 10.1136/bcr-2017-220902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A Littre's hernia is an unusual phenomenon where a Meckel's diverticulum protrudes through a potential abdominal opening. We wish to present a unique case of a 79-year-old man with respiratory distress following a fall from standing, initially managed as a haemothorax. After a chest drain was placed, bowel contents were drained from the pleural cavity and he was taken to theatre. He had a history of minimally invasive oesophagectomy for cancer and had subsequently developed a diaphragmatic hernia. A blind ending diverticulum with a perforation at its tip was found in the left oblique lung fissure that was subsequently confirmed histologically as a perforated Meckel's diverticulum. The patient had a prolonged stay on the intensive care unit with a left-sided empyema that was managed radiologically prior to discharge. Unfortunately 4 months postoperatively, he passed away from hospital-acquired pneumonia on a rehabilitation ward.
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Affiliation(s)
- Charles West
- Digestive Diseases Specialty, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Karen Erskine
- Digestive Diseases Specialty, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Khaled Hamdan
- Digestive Diseases Specialty, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Yazgan C, Sahin T, Ozmen M. Unusual cause of small bowel obstruction: mesodiverticular band of Meckel's diverticulum demonstrated by CT. BJR Case Rep 2016; 3:20150255. [PMID: 30363321 PMCID: PMC6159282 DOI: 10.1259/bjrcr.20150255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/07/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
Small bowel obstruction resulting from the mesodiverticular band is a rare complication of Meckel’s diverticulum and usually presents a diagnostic challenge. We present a case of small bowel obstruction due to the mesodiverticular band of Meckel’s diverticulum with CT scan findings.
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Affiliation(s)
- Cisel Yazgan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tolga Sahin
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mahir Ozmen
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Internal hernia associated with perforated Meckel's diverticulum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2015.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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An unusual case in which a perforated Meckel's diverticulum became trapped in a pericecal hernia: A rare complication of Meckel's diverticulum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Meckel's diverticulum mesentery along with its band forming a hernial sac: A rare case of internal herniation. Int J Surg Case Rep 2015; 10:17-9. [PMID: 25790912 PMCID: PMC4429958 DOI: 10.1016/j.ijscr.2015.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Meckel's diverticulum is the most common congenital gastrointestinal anomaly. However, only 2% of cases are symptomatic. It can cause intestinal obstruction by various mechanisms as volvulus, adhesions, Littre's hernia, intussusception. CASE PRESENTATION An unusual case of internal herniation of small bowel loops into complete hernia sac formed by unusual mesentery of Meckel's diverticulum which was present upto the adhesive band, extending from tip of the Meckel's diverticulum to the adjacent mesentery of small intestine leading to small bowel obstruction (SBO). Diverticulectomy with resection of adjacent ileum with ileo-ileal anastomosis was done. DISCUSSION Internal herniation by MD leading to SBO is an extremely rare complication. In literature, cases of internal hernia through mesentry of Meckel's diverticulum, through mesodiverticular band, adhesion of inflamed end of MD to corresponding base of mesentry, fibrous cord extending upto umblical wall have been reported but in our case, patient had both adhesion band along with internal herniation into sac formed by unusual mesentry of the meckel's diverticulum and the adhesion band. Preoperative diagnosis is often difficult with only 6-12% of cases diagnosed correctly. Surgical intervention is indicated for patients with intestinal obstruction or high risk of incarceration. CONCLUSION Meckel's diverticulum causing internal hernia is rare event. It's presentation due to herniation of bowel loops into sac formed by mesentery attached to diverticulum and the adhesion is rarest, with non specific signs and symptoms. Early diagnosis and prompt treatment prevent further complications.
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Kotha VK, Khandelwal A, Saboo SS, Shanbhogue AKP, Virmani V, Marginean EC, Menias CO. Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol 2014; 87:20130743. [PMID: 24611767 PMCID: PMC4075535 DOI: 10.1259/bjr.20130743] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract, often presenting with complications such as gastrointestinal bleeding, intussusception, bowel obstruction and diverticulitis, which are often misdiagnosed. Imaging plays an important role in the early diagnosis and characterization of these conditions and is very helpful in decision making. The Meckel's diverticulum and its complications have myriad presentations and appearances on various imaging modalities. Thus, sound knowledge of the anatomy, embryology, clinical presentation, imaging characteristics and complications is crucial to the practice of abdominal imaging. We present a review of the literature and current radiological practices in the diagnosis and management of the Meckel's diverticulum and its various complications with special emphasis on the imaging of various complications, mimickers and pathological correlation.
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Affiliation(s)
- V K Kotha
- Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Abstract
Internal hernias in which the gate is located in the paracolic gutter are rare. A 75-year-old man was admitted to our hospital with severe epigastric pain without past history of laparotomy and/or trauma. He was diagnosed with strangulation of the ileum by the findings of computed tomography, and the operation was performed. During laparotomy, the small intestine was found to be strangulated and to enter the retroperitoneum from the right paracolic gutter near the hepatic flexure. The patient was diagnosed with an internal hernia, which differed from a pericecal hernia in that the hernia gate was located along the paracolic gutter near the hepatic flexure far from the cecum. Hence, it was considered to be a rare type of internal hernia. We report the clinical presentation and imaging findings of this rare internal hernia.
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Abstract
Recent technological advances in multidetector computed tomography (MDCT) have enabled 3D diagnostic imaging with superb spatial and temporal resolution. This often provides useful information on precise detail and relationships.
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Internal hernia associated with Meckel's diverticulum in 2 pediatric patients. Am J Emerg Med 2008; 26:86-90. [PMID: 18082787 DOI: 10.1016/j.ajem.2007.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 07/05/2007] [Accepted: 07/10/2007] [Indexed: 01/16/2023] Open
Abstract
We report 2 pediatric cases of small bowel obstruction due to a Meckel's diverticulum complicated with internal hernia. Abdominal multidetector computed tomograms with multiple planar reconstructions revealed a bridge-like lesion with inconspicuous mucosal folds in the right lower quadrant formed by adhesion of the tip of Meckel's diverticulum with the adjacent mesentery, with ileal loops converging at the "bridge" and engorged mesenteric vessels. These 2 cases highlight the feasibility of multidetector computed tomography, especially in the ED, in revealing this unusual etiology of small bowel obstruction.
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Abstract
This is a case report of a 73-year-old man with a small bowel obstruction secondary to an incarcerated paracaecal hernia. His large right inguinal hernia, initially suspected as a potential source of obstruction, turned out to be a red herring. Congenital internal hernias are a very rare cause of bowel obstruction. In this report we review the literature and embryology behind these uncommon occurrences.
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Affiliation(s)
- G H M Smith
- Department of General Surgery, St. John's Hospital at Howden, Howden Road West, Livingston
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